What are the EDF treatment guidelines for hidradenitis suppurativa (HS)?

Updated: Aug 30, 2019
  • Author: Marina Jovanovic, MD, PhD; Chief Editor: William D James, MD  more...
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Answer

In the published guidelines for hidradenitis suppurativa developed by the Guidelines Subcommittee of the European Dermatology Forum, [1] it is recommended that hidradenitis suppurativa be treated based on the subjective impact and objective severity of the disease, as follows:

  • Locally recurring lesions can be treated surgically
  • Medical treatment either as monotherapy or in combination with surgery is more appropriate for widely spread lesions
  • Medical therapy may include antibiotics and immunosuppressants

A Hurley severity grade‒relevant treatment of hidradenitis suppurativa is recommended by the expert group with the following treatment algorithm:

  • Limited surgery such as deroofing and laser ablation techniques are especially suited for recurrent hidradenitis suppurativa lesions at fixed locations in Hurley 1/mild Hurley II stage
  • Wide surgical excision is appropriate for moderate Hurley II/Hurley III stage
  • Topical clindamycin is recommended for localized Hurley I stage

Systemic treatment (clindamycin + rifampin/tetracycline or acitretin) with adjuvant therapy (pain management treatment of superinfections is proposed for Hurley II stage)

  • Systemic biologics (adalimumab/infliximab) are reserved for treatment-resistant, moderate-to-severe hidradenitis suppurativa (moderate Hurley II/Hurley III stage)
  • General measures are offered for all patients and include weight loss and tobacco abstinence [1]

Based on expert opinion it is recommended that adjuvant therapy is offered to all patients in the form of general measures such as weight reduction, cessation of cigarette smoking, and specific help with bandaging lesions in order to improve the patients’ quality of life. Hidradenitis suppurativa‒specific bandages are not currently available. [1] Choice of dressing is based on clinical experience. [54] In addition, adhesive tape should be avoided to minimize trauma to inflamed skin, which can be overcome by using tubular net bandages or superabsorbent pads or materials in the seams of clothing. [2]

Regarding local wound care, superabsorbent dressings are best to treat actively draining lesions or postoperative wounds, but there are no trials or studies to support this recommendation. [1] In order to prevent the primary dressing from sticking to the wound, white petrolatum, zinc oxide paste, or film-forming liquid acrylate should be extensively and generously applied on the marginal skin as the best ways to keep the wound dressings in place. [2]


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